Page 34 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,430 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 Doctors Only 3 out of 5
Status: Health: Health Plan (some Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 exceptions) Yes
Sharing Drug Copay/ Lower Your
Part B Coinsurance: Out of Pocket Drug Costs
Annual: $288 Premium $2 - $47, 33% Spending
Reduction - 50% Limit: $3,900 MTM Program :
Mail Order :No In and Out- Yes
Annual: $131 of-network
$3,900 In-
network
$3,900 Out-
of-network

WellCare Choice (HMO-POS) (H1416-024-0)
Organization: WellCare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $39.00 Annual Drug Doctor All Your Drugs on $3,780 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $5.60 Doctors Only 3 out of 5
Status: Health: Health Plan (some Drug Restrictions: stars
Standard Cost- $33.40 Deductible: $0 exceptions) Yes
Sharing Drug Copay/ Lower Your
Part B Coinsurance: Out of Pocket Drug Costs
Annual: $315 Premium $0 - $47, 33% Spending
Reduction - 48% Limit: $3,400 MTM Program :
Mail Order :No In and Out- Yes
Annual: $198 of-network
$3,400 In-
network
$3,400 Out-
of-network

WellCare Rx (HMO) (H1416-023-0)
Organization: WellCare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $12.50 Annual Drug Doctor All Your Drugs on $3,360 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 Doctors for 3 out of 5
Status: $12.50 Most Services Drug Restrictions: stars
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your
Drug Copay/ Spending Drug Costs
Annual: $397 Part B Coinsurance: Limit: $3,400
Premium $0 - $47, 25% In-network MTM Program :
Mail Order Reduction - 50% Yes
Annual: $349 :No
WellCare Plus (HMO) (H1416-048-0)
Organization: WellCare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]

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